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Home My WebLink AboutHAZ-BUSINESS PLAN 10/31/1995 i Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE ,,,¢?~?~:~,~???,,? ?~,~, ..... This permit is issued for the following: C H U C K HAD DAD M ITS U BIS H LOCATION 5200 GASOLINE ~L~,,,~,~::'~? . BA~S~!~[D CA ~'% '"..~ ?'i .-L.':::L~., ¢.'~ "' :?.] ~ i : , :'. :: ,' ¢, ~ %~ ~ ~ '-:.~! . . %..'".:~:: .... id, ¢::'- .......... '::;~,' , ~, ,.?;~:,~ ~,~,~:~'4~:,,6~'.,¢,~,,,:,s.: ""~ .!: ~ ~::'-.::::'~ . ' '" ]ss.~ by: ~ Bake.field Fbe D.a.ment Approv~ by: O~CE OFE~O~3L S~ ~CES 1715 Chewer Ave., 3rd Floor B~e~iel& CA 93301 Voice (805) 32~3979 F~ (805) 326~576 Expiration Dat~: For Office Use Only ._~ First In Station: Area Map ~ < of ~ Inspection Station: NORTH ,. 0CT--87--99 04:11 PM CHUCK~-HAD*-I]AD 661~961657 P.02 CHUCK HADDAD MITSUBISHI 5200 GASOLINE ~.LEY P.O. BOX 41117 BAKERSFIELD, CALIFORNIA a3384.1117 PHONE (805) 10-5-1999 DEAR sI, rPPI]ERS, CUSTOMERS, FINANCIAL INSTITUTIONS. THIS IS TO INFORM YOU THAT WE HAVE CIIANGED OUR NAME FROM CH UCK HADDA D MITSUBISHI TO BAKERSFIELD MITSU BISIII. OUR ADDRESS, FEDERAL AND SALES EXEMPT IDS, PIIONE AND FAX NUMBER REMAIN TIlE SAME. WII,I, BE HAPPY TO'ANSWER ANY QUESTIONS YOU MIGIlT IIAVE. Sinccrclyl E. W. tl. Group,inc. DBA Bakersfield ,MitsubiShi ! Elias W. "Chuck" lladdad President 10/20/95 CHUCK HADDAD MITSUBISHI 215-000-0006~ [~0V - ~ge -. Overall Sits'with 1 Fac. Unit [~[ ~uv lj995 I General.Information [By Location: 5200 GASOLINE ALLEY Map:123 Haz:0 Type: 3 City : BAKERSFIELD Grid: 24C F/U: 1 AOV: 0.0 Contact Name Title Title E.W. HADDAD / OWNER/PRESIDENT ~ / SERVICE MANAGER Business Phone: (805) 398-0264x Business Phone: (805) ~ 24-Hour Phone : (805) 871-1940x 24-Hour Phone : ( )~-q~ Pager Phone : ( ) - x Pager Phone : ( ) - x Administrative Data Mail Addrs: P O BOX 41117 D&B Number: 29-315-4266 City: BAKERSFIELD State: CA Zip: 93384- Comm Code: 215-013 BAKERSFIELD STATION 13 SIC Code: 5511 Owner: ELIAS W. HADDAD Phone: (805) 871-1940 Address: P O BOX 41117 State: CA City: BAKERSFIELD Zip: 93384- r Summary I, ~ Do h~mby certify that ! h~ve reviewed the at~ached hazardous materials reel'.age- merit plan for_ ~. --- -,._.___and that it a~ong wi..~h any corrections constitute a complete and correct man- agement plan for my facility, 10/20/95 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Max Qty MCP 02-005 ACETYLENE Gas 216 High · Fire, Pressure, Immed Hlth, Delay Hlth FT3 02-003 ANTIFREEZE Liquid 100 Low · Immed Hlth, Delay Hlth GAL 02-004 OXYGEN Gas 216 Low · Fire, Pressure, Immed Hlth FT3 02-006 WASTE ANTIFREEZE Liquid 165 Low · Delay Hlth GAL 02-009 WASTE OIL Liquid 125 Low · Fire, Delay Hlth GAL 02-001 MOTOR OIL Liquid 108 Minimal · Reactive, Immed Hlth, Delay Hlth GAL 02-002 FREON Gas 200 Minimal · Reactive, Delay Hlth LBS 02-008 HELIUM Gas 216 Minimal · Reactive, Immed Hlth FT3 02-007 WASTE OIL FILTERS '~ Solid 50 Unrated · Delay Hlth LBS 10/20/95 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 3 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-005 ACETYLENE Gas 216 High · Fire, Pressure, Immed Hlth~ Delay Hlth FT3 CAS #: 74-86-2 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING Daily Max FT3 I Daily Average FT3 I Annual Amount FT3 -- 216 ~ 216.00 648.00 Storage Press T Temp~ Location PORT. PRESS. CYLINDER AmbientlAmbientlN WALL SVCE GARAGE W OF OVERHEAD -- Conc Components~ MCP ---~uide 100.0% IAcetylene "~ IHigh ~ 17 02-003 ANTIFREEZE Liquid 100 Low · Immed Hlth, Delay Hlth GAL CAS #: 107-21-1 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: COOLANT/ANTIFREEZE Daily Max GAL100I~ Daily Average40.00GAL I Annual Amount540.00GAL -- Storage · Press T Temp~ Location PLASTIC CONTAINER AmbientlAmbientlPARTS DEPT -- Conc Components MCP ---TGuide 100.0% IEthylene Glycol ILow ! 27 02-004 OXYGEN Gas 216 Low · Fire, Pressure, Immed Hlth FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING Daily Max FT3I Daily Average FT3 I Annual Amount FT3 216 I 216.00 648.00 Storage~~Press~ T~Temp Location PORT. PRESS. CYLINDER IAmbientlAmbientlN WALL SVCE GARAGE E OF OVERHEAD -- Conc! Components ~ MCP ---TGuide 100.0% IOxygen, Compressed ~Low ~ 14 10/20/95 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 4 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-006 WASTE ANTIFREEZE Liquid 165 Low · Delay Hlth GAL CAS #: 107-21-1 Trade Secret: No Form: Liquid Type: Waste Days: 365 Use: WASTE Daily Max GAL Daily Average GAL Annual Amount GAL 165 I 8.00 I 1,920.00 Storage ~~Press T Temp Location DRUM/BARREL-METALLIC IAmbient~AmbientlSE CORNER OF SVCE GARAGE BEHIND - Conci Components ~ MCP ---/Guide 0.0% IEthylene Glycol ILow ! 27 02-009 WASTE OIL Liquid 125 Low · Fire, Delay Hlth GAL CAS #: 221 Trade Secret: No Form: Liquid Type: Waste Days: 365 Use: WASTE -- Daily Max GAL I Daily Average GAL I Annual Amount GAL 125 i 12.00 2,880.00 Storage I Press T TempI Location ABOVE GROUND TANK I Ambient I Ambient I SE CORNER OF SVCE GARAGE BEHIND -- Conc. Components~ M ---~uide 100.0% IWaste Oil, Petroleum Based ILowcP ! 27 02-001 MOTOR OIL Liquid 108 Minimal · Reactive, Immed Hlth, Delay Hlth GAL CAS #: 06472-56-9A Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: LUBRICANT -- Daily Max GALI Daily Average GAL I Annual Amount GAL 108 ~ 48.00 750.00 Storage~~Press T Temp Location PLASTIC CONTAINER IAmbientlAmbientlPARTS DEPT -- Conc~ Components ~ MCP ---~uide 100.0% IMotor Oil, Petroleum Based IMinimal ~ 27 10/20/95 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 5 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-002 FREON Gas 200 Minimal · Reactive, Delay Hlth LBS CAS #: 75-71-8 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: COOLING Daily Max LBS I Daily Average LBS I Annual Amount LBS 200 I 125.00 750.00 Storage I~Press T Temp Location PORT. PRESS. CYLINDER IAmbientlAmbientlPARTS DEPT -- Conc Components MCP ---FGuide 100.0% [Dichlorodifluoromethane IMinimal I 12 02-008 HELIUM Gas 216 Minimal · Reactive, Immed Hlth FT3 CAS #: 7440-59-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: OTHER Daily Max FT3I Daily Average FT3 ----~ Annual Amount FT3 216 ~ 216.00 648.00 Storage~~Press T Temp Location PORT. PRESS. CYLINDER IAmbient~AmbientlNW WALL OFFICE/STORAGE RM CHAINE -- Conc Components MCP ---TGuide 100.0% IHeliUm IMinimal I 12 02-007 WASTE OIL FILTERS Solid 50 Unrated · Delay Hlth LBS CAS #: Trade secret: No Form: Solid Type: Waste Days: 365 Use: WASTE Daily Max LBSI Daily Average LBS I Annual Amount LBS 50 ! 5.00 1,120.00 Storage Press T Temp ~ Location DRUM/BARREL-METALLIC IA mbientl~ient[SERVICE DEPT -- Conc ! Components ! MCP ---FGuide 10/20/95 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 6 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification 1) PACIFIC GAS & ELECTRIC - (805) 324-3981 2) CALIFORNIA WATER CO - (805) 324-6011 3) PACIFIC BELL TELEPHONE - (611) OR (800) 244-4515 4) M & S SECURITY - (805) 244-4515 <2> Employee Notif./Evacuation SWITCHBOARD OPERATOR WILL NOTIFY DEPARTMENT HEARS. DEPARTMENT HEADS WILL NOTIFY EMPLOYEES IN THEIR DEPARTMENT OF EVACUATION, ALL EMPLOYEES WILL MEET AT DESIGNATED AREAS FOR HEAD COUNT. SERVICE MANAGER & SALES MANAGER WILL EVACUATE CUSTOMERS IN THEIR DEPARTMENTS. <3> Public Notif./Evacuation IF EVACUATION IS CAUSED BY A LIFE THREATENING HAZARD NOTIFY ADJACENT BUSINESS. 1) JIM BURKE LINCOLM-MERCURY - 5300 GASOLINE ALLEY - (805) 837-6470 2) BILL WRIGHT TOYOTA - 5100 GASOLINE ALLEY - (805) 398-8837 <4> Emergency Medical Plan MINOR INJURIES SHOULD BE TAKEN TO DR. CHRISTENSEN AT 2021 22ND STREET, BAKERSFIELD, CA M-F 7 A.M. TO 6 P.M. AFTER HOURS & SERIOUS INJURIES SHOULD BE TAKEN TO MEMORIAL HOSPITALS EMERGENCY ROOM AT: 420 34TH STREET, BAKERS F I ELD. 10/20/95 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 7 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention LEVELS & INTEGRITY OF ALL WASTE OIL, ANTIFREEZE & ATF STORAGE TANKS ARE MONITORED DAILY. TANKS ARE PUMPED ON A REGULARLY SCHEDULED BASIS. <2> Release Containment IN CASE OF AN ACCIDENTAL SPILL. SPILL WILL BE CONTAINED & KEPT TO A MINIMUM USING ABSORBANTS & SHOP TOWELS. TANKS WILL THEN BE PUMPED INTO ANOTHER APPROVED CONTAINER UNTIL REMOVAL & REPAIRS CAN BE COMPLETED. <3> Clean Up ~ ALL MATERIALS USED IN THE EVENT OF A SPILL WILL BE DISPOSED OF IN A SAFE & EXPEDIENT ORDER. SHOP TOWELS WILL BE REMOVED BY SUPPLIER & ABSORBANTS WILL BE CONTAINER & HAULED TO AN APPROVED HAZARDOUS WASTE FACILITY. <4> Other Resource Activation 10/20/95 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 8 00 - Overall Site <F> Site Emergency Factors <1> Special Hazards <2> Utility Shut-Offs A) GAS - SE END OF DEALERSHIP ADJACENT TO SERVICE DEPT B) ELECTRICAL - SE END OF DEALERSHIP ADJACENT TO SERVICE DEPT C) WATER - SE END OF DEALERSHIP ADJACENT TO SERVICE DEPT D) SPECIAL - NONE E) LOCK BOX - NO <3> Fire Protec./Avail. Water PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS ARE READILY MARKED AND AVAILABLE THROUGHOUT FACILITY ALL EXISTING BUILDING ARE EQUIPPED WITH SPRINKLERS. NEAREST FIRE HYDRANT - APPROXIMATELY 200 FTE S OF DEALERSHIP IN FRONT OF JIM BURKE LINCOLN FIRE HYDRANT ON S CORNER OF GASOLINE ALLEY & MOTOR CENTER ROAD. <4> Building Occupancy Level 10/20/95 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 9 00 - Overall Site <G> Training <1> Employee Training WE HAVE 50 EMPLOYEES ON SITE AT THIS~FACILITY. WE DO HAVE MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES HAVE BEEN INSTRUCTED ON OSHA, RIGHT TO KNOW, PROPER USE OF MSDS, SAFETY RULES & REGULATIONS, EVACUATION PROCEDURES & MEDICAL PERSONNEL NOTIFICATION. <2> Page 2 <3> Held for Future Use <4> Held for Future Use . BAKERSI LD CITY FIRE DEP.fl TMENT . HAZARDOUS MATERIALS INVENTORY Page 1 of J Business Narne ~../~ L,)~'__ ~/'~/'~Q (~ Address ~~ C'~ ~ O~ ~ ~~ ~i CHEMICAL DESCRI~ION 1) IN~NTORY STA~S: New [ ] Addition ~] Revision [ ] Deletion [ ] Check if chemi~l is a NON ~DE SECR~ ~ ~DE SECR~ [ ] 2) CommonN~e: ~~ ~/~ 3) ~T~ (option~) 4) PHYSICAL & H~L~ PHYSICAL H~L~ H~RD CA~GORIES Fire [ ] Reactive [ ] Sudden Rele~e of Pressure [ ] Immediate He~th (Acme) ~] Delayed He~h (Chronic) 5) WAS~ C~SSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STA~ Solid [ ] Liquid [~ G~ [ ] Pure ~ Mi~ure [ ] W~te [ ] R~ioam~e [ ] 7) AMOUNT AND ~ME AT FAClLI~ UNITS OF M~SURE 8) STOOGE CODES M~imum Daily Amount: ~~ lbs [] g~ ~] ~3 [] a) Cont~ner: ~/~ Average Daily Amount: ~ curies [ ] b) Pressure: Annu~ Amount: c) Temper~ure: ~gest Size Container: ~~ ~M~ · Days On Site ,~ ~ Circle~ich Months: ~ J, F, M, A, M, J, J, A, S, O, N, D 9) MI~URE: Dst COMPONENT CAS · % ~ AHM the throe most h~dous 1) [ ] chemi~l com~nents or ~y AHM com~nents 2), [ ] 3). [ ] 1) IN~NTORY STATUS: New [ ] Addition ~ Revision [ ] Deletion [ ] Check ~ chemic~ is s NON ~DE SECR~ ~ ~DE SECR~ [ ] 2) CommonN~e:~U~O~C ~~ ~/~ ,~d/~ 3) ~T ~'(option~) Chemic~ Name: ~ -~ ~~ ~ ~ AHM [ ] CAS · ~ 4) PHYSICAL & H~L~ PHYSICAL H~L~ H~RD CATEGORIES Fire [ ] Rea~ive [ ] Sudden Rele~e of Pressure [ ] Immediate Health (Ac~e) [ ] Delayed He~h (Chronic) 5) WASTE C~SSIFICATION .(3-digit code from DHS Form 8022) USE CODE ~ ~ 6) PHYSICAL STATE Solid [ ] Liquid ~] G~ [ ] Pure ~ Mi~ure [ ] W~te [ ] Radioactive [.] 7) AMOUNT AND TIME AT FAClU~ UNITS OF M~SURE 8) STOOGE CODES M~imum Daily Amount: ~0~ ~ lbs [ ] g~ ~ ~3 [ ] a) Cont~ner: ~/~--~ Average Duly Amount: /'~ ~ ~ cudes [ ] b) Pressure: Annual Amount: c) Temper~ure: ~gest Size Cont~ner: ~ ,~ · Days On S~e ~ Cimle~ich Months: ~llYe~J, F, M, A, M, J, J, A, S, O, N, D 9) MITRE: Ust COMPONENT CAS · % ~ AHM the three most h~dous 1) [ ] chemi~ com~nents or ~y ~M com~nents 2) '~ [ ] 3) [ ] 10) Lo.mn ce~'~ under pen~ of law, ~at I have ~emonally examin~ ~d am f~ili~ wi~ ~e infoma~on submi~ on ~is ~d ~1 a~ch~ocumenm. I believe submi~ info.afion is .e, .ccu.., and comp/e.. ~~~ ~~~~'~' / P~l~ Name & Title of A~odz~ Comply Rep~sen~'ve / I Signa~re ' Da~ BAKERSfiELD CITY FIRE DEP/ TMENT HAZARDOUS MATERIALS INVENTORY Page_of_ Business Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ] Addition [ ] Revision [ ] Deletion [ ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 8) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ ] Gas [ ] Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FAClMTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: lbs [ ] gal [ ] R3 [ ] a) Container: Average Daily Amount: · cudes [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size'Container: # Days On Site Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # % WT AHM the three most hazardous 1) [ ] chemical components or any AHM components 2) [ ] 3) [ ] 10) Location CHEMICAL DESCRIPTION 1) [NVENTORY STATUS: New[ ] Addition[ ] Revision[ ] Deletion[ ] Check if chemical is aNON TRADE SECRET [ ] TRADE SECRET [ ] 2) Common Name: 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH PHYSICAL . HEALTH HAZARD CATEGORIES Fire [ ] Reactive [ ] Sudden Release of Pressure [ ] Immediate Health (Acute) [ ] Delayed Health (Chronic) [ ] 5) WASTE CLASSIFICATION .(3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] Liquid [ [ Gas [ ! Pure [ ] Mixture [ ] Waste [ ] Radioactive [ ] 7) AMOUNT AND TIME AT FACII~ITY UNITS OF MEASURE 8) STORAGE CODES Maximum Dally Amount: lbs [ ] gal [ ,] lt3 [ ] a) Container: Average Daily Ambunt: cudes [ ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year, J, F, M, A, M, J, J, A, S, O, N, D 9) MIXTURE: List COMPONENT CAS # '% WT AHM the three most hazardous 1) [ ] chemical components or any AHM components 2) "" [ ] 3). [ ] 10,) Location ca.fy under penalty of law, that I have personally examined and am familiar with the infomation submitted on this and ail attached documents. I believe th~ submitted information is b'ue, accurate, and complete. PRINT Name & Title of Authorized Company Representetive Signature Date 10/26/93 CHUCK HADDAD MITSUBISHI ~215-000-000648 Page 1 Overall Site with 1 Fac. Unit General Information I Location: 5200 GASOLINE ALLEY Map: 123 Hazard: Unrated Community: BAKERSFIELD STATION 13 Grid: 24C F/U: 1 AOV: 0.0 Contact Name Title Business Phone 24-Hour Phone- DAVE MORGAN SERVICE MANAGER (805) 398-9482 x ) - Administrative Data Mail Addrs: P O BOX' 41117 D&B Number:~ City: BAKERSFIELD State: CA Zip: 93384- Comm Code: 215-013 BAKERSFIELD STATION 13 SIC Code: 5511 Owner: ELIAS W. HADDAD Phone: (805) 871-1940 Address: P O BOX 41117 State: CA City: BAKERSFIELD Zip: 93384- Summary reviewed th~ a~mched haza=dous m~fia~s manage- ment plan _. ~~~ __. ~h~ ~o~.~ ~_ =r~d , . it a,~cng with any corrections constit~.~te ~ ccmp~[e and correct man- agement plan for my faciii~, 10/26/93 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 2 Hazmat Inventory List in MCP Order 02 - Fixed Containers on Site Pln-Ref Name/Hazards Form Max Qty MCP 02-005 ACETYLENE Gas 216 High · Fire, Pressure, Immed Hlth, Delay Hlth FT3 02-003 ANTIFREEZE Liquid 100 Low · Immed Hlth, Delay Hlth GAL 02-004 OXYGEN ~ Gas 216 Low · Fire, Pressure, Immed Hlth FT3 02-006 WASTE ANTIFREEZE Liquid 165 Low · Delay Hlth GAL 02-009 WASTE OIL Liquid 125 Low · Fire, Delay Hlth GAL 02-001 MOTOR OIL Liquid 108 Minimal ~ Reactive, Immed Hlth, Delay Hlth GAL 02-002 FREON Gas 200 Minimal ~ Reactive, Delay Hlth LBS 02-008 HELIUM Gas 216 Minimal · Reactive, Immed Hlth FT3 02-007 WASTE OIL FILTERS Solid 50 Unrated · .Delay Hlth LBS 10/26/93 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 3 02 - Fixed containers on Site Hazmat Inventory Detail in MCP Order. 02-005 ACETYLENE Gas 216 High · Fire, Pressure, Immed Hlth, Delay Hlth FT3 CAS #: 74-86-2 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING Daily Max FT3216I~ Daily Average216.00FT3 I Annual Amount648.00FT3 -- Storage ~ Press T Temp ~ Location PORT. PRESS. CYLINDER I AmbientlAmbientIN WALL SVCE GARAGE W OF OVERHEAD -- Conc Components MCP ---TGuide 100.0% IAcetylene IHigh ! 17 02-003 ANTIFREEZE Liquid 100 Low · Immed Hlth, Delay Hlth GAL CAS~#: 107-21-1 Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use: COOLANT/ANTIFREEZE Daily Max GAL100 I' Daily.~ Average40.00GAL I Annual Amount540.00GAL -- Storage Press T_~Temp Location PLASTIC CONTAINER AmbientlAmbientlPARTS DEPT -- Conc Components MCP -~Guide 02-004 OXYGEN Gas 216 Low ~ Fire, Pressure, Immed Hlth FT3 CAS #: 7782-44-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: WELDING SOLDERING Daily Max FT3I Daily Average FT3 1 Annual Amount FT3 216 ~ 216.00 648.00 Storage~ ~Press T Temp , ' Location PORT. PRESS. CYLINDER IAmbient~AmbientlN WALL SVCE GARAGE E OF OVERHEAD -- Conc Components MCP -~Guide 100.0% IOxygen, Compressed ILow [ . 14 10/26/93 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 4 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02'006 WASTE ANTIFREEZE Liquid 165 Low · Delay Hlth GAL CAS #: 107-21-1 Trade Secret: No Form: Liquid Type: Waste Days: 365 Use: WASTE Daily Max GALI Daily Average GAL I Annual Amount GAL 165 ~ 8.00 1,920.00 Storage Press T Temp~ Location DRUM/BARREL-METALLIC AmbientlAmbientlSE CORNER OF SVCE GARAGEBEHIND -- Conc Components MCP ---~uide 0.0% IEthylene Glycol ? ILow ! 27 02-009 WASTE OIL Liquid 125 Low · Fire, Delay Hlth GAL CAS #: 221 Trade Secret: No Form: Liquid Type: Waste .Days: 365 Use: WASTE Daily Max GALI Daily Average~ GAL I Annual Amount GAL -- 125 ~ 12.00 2,880.00 Storage Press T Temp~ Location ABOVE GROUND TANK ' AmbientlAmbientlSE CORNER OF SVCE GARAGE BEHIND -- Conc~ Components~ MCP ---~uide 100.0% IWaste Oil, Petroleum Based ILow ! 27 02-001 MOTOR OIL Liquid 108 Minimal · Reactive, Immed Hlth, Delay Hlth GAL CAS #: 06472-56-9A Trade Secret: No Form: Liquid Type: Mixture Days: 365 Use': LUBRICANT Daily Max GAL I Daily Average GAL I Annual Amount GAL 108 ~ 48.00 . 750.00 Storage Press T Temp Location PLASTIC CONTAINER I Ambient/Ambient I PARTS DEPT -- Concj _ Components ! MCP ~Guide 100.0% IMotor Oil, Petroleum Based IMinimal ~ . 27 10/26/93 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 5 02 - Fixed Containers on Site Hazmat Inventory Detail in MCP Order 02-002 FREON Gas 200 Minimal · Reactive, Delay Hlth ~ LBS CAS #: 75-71-8 Trade Secret: No Form: Gas Type: Pure' Days: 365 Use: COOLING Daily Max LBSI Daily Average LBS I Annual Amount LBS 200 i 125.00 750.00 Storage~~Press T Temp Location PORT. PRESS. CYLINDER IAmbient~AmbientlPaRTS DEPT -- Conc Components MCP ---TGuide 100.0% IDichlorodifluoromethane IMinimal I 12 02-008 HELIUM Gas 216 Minimal · Reactive, Immed Hlth FT3 CAS #: 7440-59-7 Trade Secret: No Form: Gas Type: Pure Days: 365 Use: OTHER Daily Max FT3216I~ Daily Average216.00FT3 I Annual Amount648.00FT3 -- Storage ~ Press T Temp~ Location PORT. PRESS. CYLINDER I AmbientlAmbientlNW WALL OFFICE/STORAGE RM CHAINE -- Conc Components MCP Guide. 100.0% IHelium .~ IMinimal I 12 02-007 WASTE OIL FILTERS Solid 50 Unrated · Delay Hlth LBS CAs #: Trade Secret: No Form: Solid Type: Waste Days: 365 Use: WASTE Daily Max LBS Daily Average LBS Annual Amount LBS ....... 50 I 5.00 [ 1,120.00 Storage Press T Temp Location DRUM/BARREL-METALLIC IAmbientlAmbientlSERVlCE DEPT - Conc ~ Components ~ MCP ----TGuide 10/26/93 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 6 00 - Overall Site <D> Notif./Evacuation/Medical <1> Agency Notification <2> Employee Notif./Evacuation <3> Public Notif./Evacuation <4> Emergency Medical Plan 10/26/93 .CHUCK HADDAD MITSUBISHI 215-000-000648 Page 7 00 - Overall Site <E> Mitigation/Prevent/Abatemt <1> Release Prevention <2> Release Containment <3> Clean Up <4> Other Resource Activation 10/26/93 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 8 00 - oVErall Site <F> Site Emergency Factors <1> Special Hazards .<2> Utility Shut-Offs <3> Fire Protec./Avail. Water <4> Building Occupancy Level 10/26/93 CHUCK HADDAD MITSUBISHI 215-000-000648 Page 9 00 - Overall Site <G> Training <1> Page 1 WE HAVE 50 EMPLOYEES ON SITE AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: ALL EMPLOYEES HAVE BEEN INSTRUCTED ON OSHA, RIGHT TO KNOW, PROPER USE OF MSDS, SAFETY RULES & REGULATIONS, EVACUATION PROCEDURES & MEDICAL PERSONNEL NOTIFICATION. <2> Page 2 as needed <3> Held for Future Use <4> Held for Future Use Bakersfield Fire Dept. Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 6: NOTIFICATION AND EVACUATION PROCEDURES: A. _ AGENCY NOTIFICATION PROC2URES: B, EMPLOYEE NOTIFICATION ANDEVACUAT:ON: N _ ,1_..~ , Bakersfield Fire Dep~ Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A, RELEASE PREVENTION STEPS: B, RELEASE CONTAINMENT A~.D/OR MINI~IZ~ION: ' - C, CLEAN-UP PROCEDURES: SECTION8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITy): ATURAL GAS/PROPANE: ~~ ~'~ ~~,~ ~~~ ~ ~~~, - ~ , ' . - ~~.~.~/ ~ - ~ ~ ~ ~ o. - SPECIAL' LOCK BOX: YES~ IFYES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER AVAILABILITY: A. PRlyATEF,IREPF~OTECTI.O._~_N: ~'1~ C~.T/tUql.4,15,J~,~-.5- t~"d,~ B. WATER AVAILABILITY (FIRE HYDRANT): ,~ m J'~ Bakersfield Fire Dept. Hazardous Materi~ls Division 2130 "G" Street Bakersfield, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN 1. To avoid further action, return $his form within 30 days of receipt. (April .23, 1993) ' ~ ~P~/_PRJ~T_~sw~_~S_ IN ENGLISH.t~_b~si~ess ~a ~h01~.' 3. Answ. er the questions below for 4. Be brief and concise as po~ible. " SECTION 1' BUSINESS IDENTIFICATION DATA BUSINESS NAME E.W.H. ~roup, ~nc. DUN ~ BRADSTREET NUMBER: SIC COD~: SECTION 2: EMERGENCY NOTIFICATION: CONTACT TITLE BUS. PHONE 24 HR. PHONE Bakersfield Fire Dept. ~' ...... Hazardous Materials Division HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION 3: TRAINING: NUMB.ER .OF EMPLOYEES: ~E./~,,~eE MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: SECTION 4: EXEMPTION REQUEST: CERTIFY UNDER PENALTY OF PERJURY THAT MY BUSINESS IS EXEMPT FROM THE REPORTING REQUIREMENTS OF CHAPTER 6,95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS' , WE DO NOT HANDLE HAZARDOUS MATERIALS. WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECIFY REASON) SECTION 5: C[RTIFIC~TION: ,"~~,.E_ .-~['? ~L~~~ CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLiGATiONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS .(DIV;' 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. GNATURE DATE FO159t3 BAKERSFIELD CITY FIRE DEPARTMENT , H/~ZARDOUS MATERIALS DIVISION 2130 "G" STREET BAKERSFIELD, CA. 93301 ' (805) 326-3979 HAZARDOUS MATERIALS INVENTORY FACILITY DESCRIPTION CHECK IF BUSINESS IS A FARM [ ] NAME SITE ADDRESS~ ~.~~ ~/~O A/~4..)~' E% SiC CODE ~// DUN & BRADSTREET NUMBER MAILING ADDRESS '~'~-~.)~' q ]//~ ~;~ CITY ~~'~~ (-~)~L STATE ~ ZIP ¢_~ d~¢ ¢/6f'''' EMERGENCY CONTACTS BUSINESS PHONE ..~'~; '"- (--)~(~ 24-HOUR PHONE NAME '"~'YI~_~_ /~ TITLE ~'6' 8eFXemt:~er 30, 1992 REGION V LEPC STANDARD FORM BAKERSI LD CITY DEPAtI i'M ENT HAZARDOUS MATERIALS INVENTORY T~ CHEMICAL DESCRI~ION 1) INVENTORY STA~S: New [ ] Addition [ ] Revision [~Deletion [ ] Check if chemical is a NON ~DE SECR~ [ ] ~DE SECR~ [ ] 2) Common N~,: ~~ ~~- '~J~J~O~ ~~ 3) ~T ¢ (optional) _ 4) .HYS~CAL & H~L~ .HYS~CAL H~L~ H~RD CATEGORIES Fire [ ] Reactive' Sudden Rele~e of Pressure [ ] Immediate Health (Ac~e)~ ~layed He~h (Chronic)~ 5) wAs~ c~ss,~c,no, ~! (~-~i¢ con. ~o~ ~,s ~o~ ~0~) use coo~ A~. 6) PHYSICALSTA~ Solid [ ] Uquid~ G~ [ ] Pure [ ] M~ure~, W~te [ ] Radioa~Ne [ ] 7) AMOUNT AND ~ME AT ~ACIU~~ UNITS OF M~SURE 8) STOOGE CODES Average D~ly Amount: ~ CUrler' .[ ]~ b) Pressure: Annu~ Amount: c) Tem~r~ure: ~gest Size Container: 9) MI~URE: Ust ~ ~ ~O~PONENT ~~~~ ~ ~_ __ CAS ~ % ~ AHM CHEMICAL DESCRI~ION 1) INVENTORY STA~S: New [ ] Addition [ ] Revision [_, __letion [ Check ~ chemi~ is a NON ~DE SECR~ [ ] ~DE SECR~ [ ] 2) Common N~e~~~ ~ ~ ~ 3) ~T · (option~) H~RD CATEGORIES Fire [ ] Reactive~ Sudden Rele~e of Pressure [ ] Immediate Heath (Ac~e) 5) WASTE C~SSIFICATION ~ / (3-digit code from DHS Form 8022) USE CODE 6) PHYSICAL STATE Solid [ ] biquid~ 6~ [ ] Pure [ ] Mi~ure~ W~te [ ] Radioactive M~imum Daily ~moun¢. Ib~ [ ] ~ ~ ~0 ~ ] ~) Contmnor: Average Daily Amount: curiei [ ] b) Pressure: Annu~ Amount: c) TemperMure: ~gest Size Cont~ner: · DaysOnS~e '~'~ Circle~ichMonths:~ AII~J, F, M, A, M, J, J, A, S, O, N, D chemic~ com~nen~ or c~ [~ o /~ t ?e~'~ under pen~ of law, ~at I have pe~onally ~x~in~ ~d ~ f~ili~ wi~ ~e ~oma~n submittals ~d ~u~iff~ info~afion is ~e, accumte~and complete/ ~ [ ~ ~ ~ -*" BAKERSFiIILD DEPAI MENT , ,. ...... CITY FIRE ',;' HAZARDOUS MATERIALS: INVENTORY Pag :~of~_-:~- Business Name ~' Address ~'~,)/_] CHEMICAL DESCRI~ION 1) IN~NTORY STA~S: New [ ] Addition [ ] Revision [ ] Deletion [ ] ~hec~.if~emi~ is a NON ~DE SECR~ [ ] ~DE SECR~ [ ] Chemi~ Name: J~ 0 [ OWI~ . . _ AHM [ ] CAS · 4) PHYSICAL & H~L~ PHYSICAL H~L~ H~RD CA~GORIES Fire [ ] Reactive [ ] Sudden Rele~e of Pressure ~ Immediate He~h (Ac~e) [ ] ~layed He~h (Chronic) [ 5) WAS~ C~SSIFICA~ON (3-digit code from DHS Fo~ 8022) USE CODE 6) PHYSICAL STA~ Solid [ ] Liquid [ ] G~ Pure [ ] M~ure [ ] W~te [ ] Radioa~Ne [ ] 7) AMOUNT AND ~ME AT FAClU~ UNITS OF M~SURE 8) STOOGE CODES ] ,3 [ ] a) Co.t~ner: , Average Dmly Amount: b) Pressure: :, ~nu~ Amount: c) Tem~r~ure: ~gest ~ize Container: ~~~ AIl Ye~ · Days On Site ~ Circle~ich Months J, F, M, A, M, J, J, A, S, O, N, D 9) MITRE; ~st ~ ~ COMPONENT ~~ CAS~ [/ AHM chemic~ components or ~y AHM com~nen~ 2) [ 3) [ ] 10) Location ;" ::Ria:::~S: ~;dd~~;:~_ :7~~/~~~emic. is a NON3,~DE~T .SECR~ [ ](option.) ~DE SECR~ [ ] ., H~L~ 4) PHYSICAL & H~L~ PHYSICAL H~RD CATEGORIES Fire [ ] Reactiv~;~' Sudden Rele~e of Pressure [ ] Immedi~e Health (Acme) ~ Delayed He~h (Chronic) 7) AMOUNT AND ~ME AT FAClU~ UNITS OF M~SURE 8) STOOGE CODES M~imum Daily Amount:' ~ lbs" :'g~3 [ ] a) Cont~ner: Average D~ly Amount: ~' cude~ [ ] b) Pressure: Annual Amount: ~. c) Tem~r~ure: ~gest Size Cont~ner: ~~'. ~DaysOnS~e ~ Circle ~ich Months: ~ J, F, M, A, M, J, J,.A, S, O, N, D the throe most h~dous 1) ~ ~, ~ I f~ ~ [ ] chomi~com~nentsor ~ ii J-- I , I-1~ r. D ... ~y ~M com~nents 2)_~I ~A~ I?~3 ~ (~/A~ ~ I 1 I-~ ~ 10) Lo~ion ~ ~ ce~'~ under pen~ of law, ~at I have persondly ex~in~ and am f~iliar wi~ ~e infoma~on submi~n ~is~ ~1 a~ch~ documenm. I believe su~ info~a~on is ~e, accurate, and compJete. ~ ~. ...... ( ~ // PRI~ Name & Title of A~oriz~ Com~ny ~epresenm~ve / Signa~re / BAKERSfiELD CITY DEPA h'M ENT FIRE I HAZARDOUS MATERIALS INVENTORY Page_~L~--~ Business Name [ Address ~b CHEMICAL DESCRI~ION 1) INVENTORY STA~S: New [ '] Addition [ ] Revision [ ] Deletion [ ]/ Check if chemicsl is ~ NON ~DE SEOR~ [ ] ~DE SECR~ [ ] 2) Common Name: OX~ ¢~ ¢ O) ~T, (optional) 4) PHYSICAL & H~L~ PHYSICAL ,--, H~L~ H~D CATEGORIES Fire [ ] ~eactive [ ~ Sudden ~ele~e of Pressure ~ Immedi~e He~th (Ac~e) [ ] ~layed He~h (Chronic) [ ] 6) PHYSICAL STA~ Solid [ ] Liquid [ ] G~ Pure~Mi~ur. [ ] W~te :..~ Redio~tive [ ] 7) AMOUNT AND ~ME AT FAClU~ UNITS OF M~SURE ~) STOOGE CODES' M~imum D~ilyAmount: ~/~ ~ I~ [ ] g~ [] ~3 [ ] a) Cont~ner: Annual Amount: ~ c) Tem~r~um: , ~gest Size Container: ~/~~ · Days On Site ~ ~ Circle~ich Months:~,)J, F, M, A, M, J, J, A, S, O, N, D 9) MI~URE: Mst ~ __ COMPON~T CAS~ ~ AHM chemic~ components or ' ~y AHM com~nents 2) [ ] 3) [ ] CHEMICAL DESCRI~ION 1) IN~NTORY STA~S: New ~ Addition[ ] Revision [ ] Oelet Check ~ chemi~ is a NON ~DE SECR~ [ ] ~DE SECR~ [ ] Chemic, Name: J~~ ~'~ . AHM[] 'CAS' PHYSICAL 4) PHYSICAL & H~L* H~L~ H~RDCATEGORIES Fire~ Rea~ive[ ] SuddenRele~eofPressur¢ Immedi~eHealth(Ac~e)~__~ ~layedHe~h(Chroni II 5) WASTE C~SSIFICATION .(3-digit code Eom DHS Fo~ 8022) USE CODE ~ ~ 6) PHYSICAL STATE Solid [] Liquid [] G~ Pure~Mi~ure [] W~te [] Rsdios~ive [] 7) ~OUNT ANO ~aE AT FAC~U~~,~/ ~ ,~ UN~TS OF ~SU.E S) STO~E COOES M~imum Daily Amount: ~ lbs [ ] gN [ ] ~3 [ ] a) Cont~ner: Average D~ly Amount: ~ cudes [ ] b) Pressure: Anna, Amount: ~~ c) Tem.r~ure: ~gest Size Container: ~-.~ ~~ C Days On Site ~&¢~-- Circle ~ich Months , F, M, A, M, J, J, A, S, O, N, O thethree most h~dous 1) n ~ &~ J6~ ~ [ ] chemic~ com~nen~ or [ ' - ~ ' ~ ...... ~y AHM com~nenm 2) [ / ~ ~' [ ] r ce~'~ under pen~ of law, ~at I have personally examin~ ~d ~ f~ili~ wi~ ~e'~o~on' S~bmi¢~ on ~is ~a~ch~ d~enm. I believe ~ubmi~ info~a~o~is ~cumte, ~d complem. ~ ~ % ~ [ ~ ~ m ~i o ~o ' ed m~yRepresen~ ~ S'gn e Da~ ' ;' BAKERSI LD CITY FIRE DEPA ki'MENT i' HAZARDOUS MATERIALS INVENTORY Page~of~ ',usiness Name (' Address~--~,~)(-~ CHEMICAL DESCRI~ION Che~hemicsl 1) INVENTORY STA~S: New[ ] Addition[ ] Re~ion[ ] Deletion[ ] Chemi~ N~e: AHM [ ] CAS 4) PHYSICAL & H~L~ ~SICAL H~L~ H~RO CATEGORIES Fire [ ] Reactive~ Sudden Rele~e of Pressure [ ] Immedi.te Health (Ac~e)'~ ~layed He.Eh (Chronic)~ 5) WASTE C~SSIFICATION ~[ (3-digit code from DHS Form 8022) USE CODE 6) PHYSICALST.~ Solid [ ] Liquid~ G. [ ] Pure [ ] Mi~ur.~ W. te~ R. ioamive [ ] M~imum DalyAmount: ~ lbs [ ] ga~ff3 [ ] a) Container: Average D~ly Amount: cude= [ ] b) Pressure: / ~gest Size Container: ~ 9) MITRE: Ust COMPONENT CA8 · % ~ AHM the three mo~t h~dou~ 1) [ ] ¢hemi~ ¢om~nents or any AHM com~nent~ 3) [ 3) [ ] CHEMICAL DE'ION I) IN~NTORY STA~S: New [ ] Addition I ] Revision [ ] Deletion [ ] ~ Check ~ chemical is · NON ~DE SECR~ ( ] ~Dfi SECR~ [ ] Chemic~ Name: AHM [ ] ~AS 4) PHYSICAL & H~L~ PHYSICAL H~L~ H~RD CATEGORIES Fire [ ] Reactive [ ] Sudden Rele~e of Pressure [ ] Immediate He~th (Acute) [ 5) WASTE C~SSIFICATION (3-digit code from DH$ Form 8032) ~ COOE 7) AMOUNT AND ~ME AT FAClU~ ~ UNITS OF M~$URE ~) M~imum Daily Amount: ~ t~ [ ] g~ [ ] ~3 [ ] a) Contaner: Average D~ly Amount: ~ cudet [ ] b) Pressure: Annu. Amount'. ~ ~ c) Tem~r~ure: ~gest Size Contmner: · Days On Site Circle ~ich Months:~ ' J, F, M, A. M, J, J, A, S, O, N, D 9) MITRE: ~t COMPONENT CAS · % ~ AHM the three moet h~dous 1) { ] chemic~ com~nen~ or ~y ~M com~nents 2)_ [ ] " BAKERSi LD CITY FIRE DEPARTMENT /' HAZARDOUS MATERIALS INVENTORY Page __.of CHEMICAL DESCRIPTION 1) INVENTORY STA~S: New [ } Addit[on~ ~'~[ } Revision [ ] Deletion [ ~ Check if chemic~ is a NON ~DE SECR~ 2) Common N~e: . ~ ~.~ . ........ ~ ,, 3) ~T ~ (optionN) f ~---- 5) PHYSICAL STA~ Solid [ ] Liquid [ ] G~ Pure~Mi=ure { ] W~te { ] R~ios~ive 7) AMOUNT AND ~E AT FACILIW ~/~ ~ UNITS OF M~SURE 8) STOOGE CODES M~imum O$1y Amount: ~ ~ lbs [ ] gal [ ] fi3 [ ] a) Container: Aversge O~ly Amount: ~ ~ curies { I b) Pressure: AnnuN Amount: ~ ~ c) Tem~rature: ~,, ~gest Size Container: · Da~OnSite Circle ~ich Months; . J, F, M, A, M, J, J, A, S, O, N, D chemi~ com~nents or ~y AHM ¢om~nents 2) ,~ [ ] CHEMICAL DESCRI~ION 1) IN~NTORYSTA~S: New( I Additionl. ] Re~ision[ ] Deletion[ ] ~' Check~chemi~alisaNON~DESECR~ [ I ~DE SECR~ [ ] Chemic~ N~e: AHM [ ] CAS · 4) PHYSICAL & H~Lm ,.PHYSICAL H~Lm H~RD CATEGORIES Fire [ i Reactive~ Sudden Rele~e of Pressure [ J Immediate He~h (Acute) ~ ~layed He,th (Chronic~ / 5) WASTE C~SSIFIOATION ~ ( {3-digit code from DHS Form 8022) USE COOE ,, ...... '";' ~{~ ~r~ , ,, , , 7) AMOUNT AND ~ME AT FACIU~ UNITS OF M~SURE 8) STOOGE CODES M~imum Osily Amount: /~~ I~ [ ] g~ fi3 [ ] s} Cont~ner; Average Daly Amount: ~ cud~ [ ] b) Pressure: Annu~ Amount: ~ c) Tem~r~ure: , , ~ ,, ~gest Size Cont~ner: · Days On Site ~ Circle~ich Months:~ AIIYe~ J, F, M, A, M, J, J, A, S, O, N, D 9) MITRE: ~st COMPONENT CAS · % ~ AHM the three most h~dous 1) [ ] chemic~ com~nen~ or ~y ~M com~nents 2)_ [ 3) . [ i : e~ Under ~enal~ of law, ~at I hav~ ~rsonal/~'examined ~d am"lamilia/ wi~ ~e inN~a~n submiffed On ~nd all ~ch~ documenm. I ~mi~ info~a~is ~ accurate, an~complete. [ ~ ~ [ ~ / / Signamr~ qlNT Name & Tige of ~u~oriz~ Company RepreSenm~ Da~